The Complete Credentialing Checklist for New OB/GYN Providers

Credentialing a new OB/GYN provider is one of those projects that's easy to start too late and hard to finish quickly. Every week a provider sees patients before enrollment is effective is a week of claims at risk. This checklist walks through every step, in the order that keeps the process moving.

Step 1: Gather documents once

Collect these before starting any application — most payers ask for the same things:

• Current state medical license(s) — and licenses in any state where the provider will practice
• DEA registration and state controlled-substance registration, where required
• Board certification or board-eligibility documentation (ABOG)
• Medical school diploma and residency/fellowship certificates
• Current CV with month/year dates and no unexplained gaps over six months
• Malpractice insurance face sheet showing coverage limits and dates
• Malpractice claims history (and explanations, if any)
• Hospital privileges or admitting arrangements (or applications in process)
• Government-issued photo ID
• Professional references, if requested
• Practice information: legal name, tax ID, Type 2 NPI, service locations, hours

Store them securely and track expiration dates.

Step 2: Set up identifiers

• Type 1 NPI for the provider (or confirm the existing one and update the address and taxonomy)
• Taxonomy code in NPPES — 207V00000X for Obstetrics & Gynecology, or a subspecialty code. See our OB/GYN taxonomy code guide.
• Type 2 NPI for the practice, if not already in place
• Confirm the provider will reassign benefits to the group's tax ID

Step 3: CAQH ProView

• Create or update the provider's CAQH profile
• Upload all documents
• Authorize each payer to view the profile
• Attest — and set reminders to re-attest every 120 days

An incomplete or unattested CAQH profile stalls nearly every commercial application.

Step 4: Apply to payers in priority order

Prioritize by expected patient volume:

1. Medicare — enrollment through PECOS (CMS-855I for the individual, reassignment to the group). Required for Medicare patients and often referenced by other payers.
2. State Medicaid and Medicaid managed care plans — critical for obstetrics, since Medicaid covers a large share of births. State Medicaid enrollment and each MCO's credentialing may be separate processes.
3. Largest commercial payers in your area.
4. Remaining commercial and regional plans.
5. TRICARE if you serve military families.

For each application, record the submission date, reference number and follow-up date.

Step 5: Follow up — relentlessly

• Check application status every one to two weeks
• Respond to requests for information within days, not weeks
• Escalate stalled applications with the payer's provider relations team

Most credentialing delays come from incomplete applications and slow responses to payer requests, not from the payer's official processing time. See how long payer credentialing really takes.

Step 6: Confirm effective dates and IDs

• Effective date for each payer
• Provider ID or participation confirmation
• Fee schedule (if contracting at the group level, confirm the provider is linked to the group contract)
• Directory listing accuracy

Share this with billing so claims are released only when the provider is effective.

Step 7: Hospital privileges — in parallel

Delivering and operating providers need hospital privileges, which follow their own medical staff credentialing process and timeline. Start this at the same time as payer credentialing. Some payers ask for hospital affiliation before completing credentialing for a delivering provider.

Step 8: Plan the schedule around enrollment

While applications are in process:

• Schedule the provider with patients whose plans are already effective
• Hold claims for payers that allow retroactive effective dates
• Don't bill under another provider's NPI — that creates compliance problems
• Track which payers are pending so the front desk can schedule accordingly

Step 9: Maintain enrollment

• CAQH re-attestation every 120 days
• Payer re-credentialing (commonly every two to three years)
• Medicare revalidation on CMS's schedule
• License, DEA, board certification and malpractice renewals
• Updates for new locations or changes in practice information

Special considerations for midwives and NPs

Certified nurse-midwives (taxonomy 367A00000X) and women's health or OB/GYN nurse practitioners (363LW0102X, 363LX0001X) need their own NPIs and enrollments. Payers vary in whether they credential advanced practice providers independently or allow incident-to billing under a physician, which has strict requirements. Map each payer's rules before the provider starts.

Credentialing timeline at a glance

Mistakes that delay new OB/GYN providers

• Waiting for the provider's first day to begin applications
• Leaving the CAQH profile incomplete or unattested
• Forgetting to link the provider to the group's contract and tax ID
• Mismatched addresses or taxonomy between NPPES, CAQH and applications
• Starting hospital privileges late, which delays payer credentialing for delivering providers

Get help credentialing your new provider

Our credentialing service handles CAQH, Medicare, Medicaid and commercial enrollment, follows up until each application is effective, and coordinates with billing. Send us a WhatsApp message with your provider's start date — we'll put together a free timeline.